Doctor Name: | KEVIN MILAM |
NPI Number: | 1295173698 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | R.T.(R) |
License Number: | |
Business Practice Address: | 806 S Harvey St Coalgate, OK - 745383818 |
Business Phone Number: | 5802588772 |
Business Fax Number: | |
Mailing Address: | 806 S Harvey St, COALGATE |
State: | OK |
Postal Code: | 745383818 |
Phone Number: | 5802588772 |
Fax Number: | |
NPI Enumeration Date: | 06/06/2013 |
NPI Last Update Date: | 06/06/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 2471C3402X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Technologists, Technicians & Other Technical Service Providers |
Taxonomy Classification: | Radiologic Technologist |
Taxonomy Specialization: | Radiography |
Taxonomy Definition: |